CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE FOURTH CIRCUIT.

Respondent employee was provided coverage under a
prepaid group health plan purchased by her employer from
petitioner Blue Shield of Virginia (Blue Shield). The plan
provided reimbursement for part of the cost incurred by
subscribers for outpatient treatment for mental and nervous
disorders, including psychotherapy. However, Blue Shield's
practice was to reimburse subscribers for services provided by
psychiatrists but not by psychologists unless the treatment was
supervised by and billed through a physician. Respondent was
treated by a clinical psychologist and submitted claims to Blue
Shield for the costs of the treatment. After the claims were
routinely denied because they had not been billed through a
physician, respondent brought a class action in Federal District
Court, alleging that Blue Shield and petitioner Neuropsychiatric
Society of Virginia, Inc., had engaged in an unlawful conspiracy
in violation of § 1 of the Sherman Act to exclude psychologists
from receiving compensation under Blue Shield's plans. She
further alleged that Blue Shield's failure to reimburse was in
furtherance of the conspiracy and had caused injury to her
business or property for which she was entitled to treble damages
under § 4 of the Clayton Act, which provides for recovery of
such damages by "[a]ny person" injured "by reason
of anything" prohibited in the antitrust laws. The District
Court granted petitioners' motion to dismiss, holding that
respondent had no standing under § 4 to maintain her suit. The
Court of Appeals reversed.

Held:

Respondent has standing to maintain the action under § 4 of
the Clayton Act. Pp. 472-485.

(a) The lack of restrictive language in § 4 reflects
Congress' expansive remedial purpose of creating a private
enforcement mechanism to deter violators and deprive them of the
fruits of their illegal actions, and to provide ample
compensation to victims of antitrust violations. In the absence
of some articulable consideration of statutory policy suggesting
a contrary conclusion in a particular factual setting, § 4 is to
be applied in accordance with its plain language and its broad
remedial and deterrent objectives. Pp. 472-473.

(b) Permitting respondent to proceed does not offer the
slightest possibility of a duplicative exaction from petitioners,
Hawaii v. Standard Oil Co., 405
U.S. 251, and Illinois Brick Co.
v. Illinois, 431 U.S. 720, distinguished, since she had
paid her psychologist, who thus was not injured by Blue Shield's
refusal to reimburse respondent. And whatever the adverse effect
of Blue Shield's actions on respondent's employer, who purchased
the plan, it is not the employer as purchaser, but its employees
as subscribers, who are out of pocket as a consequence of the
plan's failure to pay benefits. Pp. 473-475.

(c) In determining whether a particular injury is too remote
from the alleged violation to warrant § 4 standing,
consideration is to be given (1) to the physical and economic
nexus between the alleged violation and the harm to the
plaintiff, and (2), more particularly, to the relationship of the
injury alleged with those forms of injury about which Congress
was likely to have been concerned in making defendant's conduct
unlawful and in providing a private remedy under § 4. Pp.
476-478.

(d) Respondent's injury is not rendered "remote"
merely because the alleged goal of petitioners was to halt
encroachment by psychologists into a market that physicians and
psychiatrists sought to preserve for themselves. Here, the § 4
remedy cannot reasonably be restricted to those competitors whom
petitioners hoped to eliminate from the market. Denying
reimbursement to subscribers for the cost of treatment was the
very means by which it is alleged that Blue Shield sought to
achieve its alleged illegal ends, and respondent's injury was
precisely the type of loss that the claimed violations would be
likely to cause. Nor is the § 4 remedy unavailable to respondent
on the asserted ground that standing should be limited to
participants in the restrained market in group health care plans
-- that is, to entities, such as respondent's employer, who were
purchasers of group health plans. Respondent did not allege a
restraint in the market for group health plans, but instead
premised her claim on the concerted refusal to reimburse under a
plan that would permit reimbursement for psychologists' services.
As a consumer of psychotherapy services entitled to financial
benefits under the Blue Shield plan, she was within that area of
the economy endangered by the breakdown of competitive conditions
resulting from Blue Shield's selective refusal to reimburse. Pp.
478-481.

(e) Section 4 standing is not precluded on the asserted ground
that respondent's injury does not reflect the
"anticompetitive" effect of the alleged boycott. Her
injury was of a type that Congress sought to redress in providing
a private remedy for violations of the antitrust laws. Respondent
did not yield to Blue Shield's coercive pressure to induce its
subscribers into selecting psychiatrists over psychologists for
the services they required, but instead bore Blue Shield's
sanction in the form of an increase in the net cost of her
psychologist's services. In light of the conspiracy here alleged,
respondent's injury "flows from that which makes defendants'
acts unlawful," Brunswick Corp. v. Pueblo Bowl-O-Mat,
Inc., 429 U.S. 477, 489, and falls squarely within the area
of congressional concern. Pp. 481-484.